Repro 9 - Ovarian Disorder

Question 1

Where in the ovary does Oognesis occurs?

Answer 1

In the follicles that are located in the cortex of the ovary.

Question 2

What is the length of time that a corpus luteum have?

Answer 2

Around 14 days.

Question 3

In the two cell theory of estrogen production, which cells does LH stimulate?

Answer 3

Theca cells.

Question 4

In the two cell theory of estrogen production, which cells does FSH stimulate?

Answer 4

Granulosa cells.

Question 5

What is the average age of menopause?

Answer 5

Around 51 years of age.

Question 6

What is the definition of menopause?

Answer 6

1 year w/o menses.

Question 7

What is premature ovarian failure?

Answer 7

Premature atresia of follicles before the age 40. There is a decrease of estrogen and inhibin. Increase in FSH and LH.

Question 8

What would be the causes of anovulation?

Answer 8

First few years after menarche. Pregnancy (always do it). Endocrine (thyroid, hyperprolactinemia, Cushing, Adrenal insuf). HPO axis (Premature ovarian failure, stress, starvation, anorexia, obesity).

Question 9

What are the diagnostic criteria of PCOS?

Answer 9

Oligo- or anovulation. Hyperandrogenism. Polycystic ovaries on Ultra Sound (a bunch of 3 to 5 mm follicles) on the periphery of the ovary “string of pearls”. You need only 2 of the 3 to make the diagnosis.

Question 10

What are symptoms that can be related to PCOS?

Answer 10

Obesity. Insulin resistance.

Question 11

What is the difference b/w Hirsutism vs Virilization?

Answer 11

Hirsutism: Male pattern hair growth, acne, muscle mass. Virilization: Male-pattern balding, deepening of voice, Clitoromegaly.

Question 12

What is the pathophysiology of PCOS?

Answer 12

There is an increase in LH, increasing LH/FSH levels. The LH stimulates the theca cells to produce the androgen. However, since the FSH stays low (due to the increase in sex hormones), it cannot convert all the androgens into estrodial, causing the virilization: Anovulation results from dysregulation of hormornes.

Question 13

How does insulin resistance tie in into PCOS?

Answer 13

Increase insulin resistance leads to increased insulin levels: Insulin stimulates androgen production in theca cells. Insulin and androgen suppress sex hormone binding globulin production.

Question 14

What is the treatment for PCOS?

Answer 14

Weight loss. Metformin. Progesterone. Clomiphene. Leuprolide. Spironolactone.

Question 15

What do we use to bring back ovulation in PCOS patients?

Answer 15

Clomiphene. Leuprolide (in pulsatile form). Spironolactone. Ovarian drilling.

Question 16

What is the mechanism of action of Clomiphene?

Answer 16

Partial agonist at estrogen receptors in hypothalamus. Decreases negative feedback by estrogen, Increasing FSH.

Question 17

What are the side effects of Clomiphene?

Answer 17

Hot flashes. GI and breast discomfort. Vision changes. Use too much and it causes ovarian hyperstimulation and enlargement, which causes pain, torsion, and may cause birth of twins.

Question 18

What is the mechanism of action of Letrozole?

Answer 18

Aromatase inhibitor.

Question 19

What is the underlying cause of PCOS?

Answer 19

Elevation in Luteinizing hormone.

Question 20

A patient w/ PCOS is most at risk for developing which type of cancer?

Answer 20

Endometrial cancer.

Question 21

Under what circumstances would you expect to see an elevated LH?

Answer 21

Normal surge before ovulation. Menopause. PCOS. Androgen insensitivity syndrome.